The WHO recommends that women breastfeed their children for up to two years or longer and the NHS promotes breastfeeding for the general population through a variety of means (eg, breastfeeding lessons, support groups, “bosom buddies”). [1] How is it then, that NHS doctors themselves feel unable to continue breastfeeding once they return to work?
UK breastfeeding rates are among the lowest in the world. [2] UNICEF highlighted that, while 81% of new UK mothers start breastfeeding, only 1% continue to exclusively breastfeed until their child is six months old. [3] Seventy seven percent of the NHS’ 1.7 million strong workforce are women and almost 50% of NHS doctors are women. [4, 5, 6]
The NHS recommends that employers should provide basic provisions for women to express milk at work. This includes break allowances, a clean private room, and a fridge for milk storage. Surely it therefore stands to reason that female NHS employees would also be supported to breastfeed?
Unfortunately, we have heard anecdotal evidence from over 300 NHS colleagues via social media, about their breastfeeding experiences when returning to work from maternity leave, suggesting that this is not the case. Examples are below:
“I was refused permission to keep my pump parts in the fridge to save on washing between expressing.”
“Colleagues expressed surprise that I was ‘still’ breastfeeding.”
“I was discouraged by my female consultant saying that she was happy for me to express but I may find that some frown upon it and I may not want to share my wishes.”
“My female consultant told me to stop and give the baby a bottle.”
“The team didn’t allow me enough breaks… an embarrassing and unpleasant journey expressing at work.”
“I had previously heard staff members at this hospital ridiculing other trainees who needed to express milk… I didn’t even try.”
“A male consultant asked me ‘did you hear the babies cry?’ as I had leaked through my scrubs. I went to get changed and cried- I was mortified.”
It is very unusual for a woman returning to work in the NHS after maternity leave to be asked if she intends to express breast milk on her return and very few are offered facilities such as a clean private room and a fridge.
Many women are expressing in unlocked rooms, toilets, changing rooms, cars, stairwells; even broom cupboards. Some women are even being told to stop breastfeeding, are being humiliated and ridiculed in front of colleagues, and are in agony with mastitis. Almost half the women we talked to reduced feeds or stopped breastfeeding completely as a direct result of their difficulties expressing at work.
Despite these setbacks, sick leave days among these women are minimal. However, after negative experiences of breastfeeding a first child on return to work (due to direct workplace difficulties), some NHS employees are taking longer periods of maternity leave for subsequent children.
Given the nature of medical training, it would not be unrealistic for a new mother to have to return to work in a completely new placement. Under such circumstances, a woman may not only feel incredibly awkward asking for support to breastfeed, but issues concerning maternal mental and physical health, domestic abuse, complications for the child can also be overlooked.
The above demonstrates that there are serious issues with pastoral care. If there is not a supportive environment for women to return to, this will have a direct impact, not only on our patients, but on our most valued asset: our NHS workforce.
Providing adequate support for women may lead to shorter periods of maternity leave. It could also have a direct influence on national breastfeeding figures as, with the right support, our patients can benefit from our experience.
Our advice to women who wish to express milk at work is:
- Request a copy of your employer’s breastfeeding policy
- Inform your employer in writing that you intend to express, prior to your return
- Be aware of the facilities you are entitled to
- Go for it! You are doing something wonderful.
Hollie Hearfield: I currently work as an ST4 in Child and Adolescent Psychiatry in Liverpool. I have three young children. As I have had difficult experiences trying to continue breast feeding upon return to work, this is a subject I feel incredibly passionate about.
Jennie Collier: I currently work as a Child and Adolescent Mental Health Services (CAMHS) ST4 in Liverpool, am a mum of two, a reasonably good ice skater, and a breastfeeding advocate.
Competing interests: Both authors have been invited to attending a local government run breast feeding research collaboration.
References
1. http://www.who.int/topics/breastfeeding/en/
2. https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/
3. https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/
4. https://www.bbc.co.uk/news/magazine-17429786
5. http://www.nhsemployers.org/-/media/Employers/Publications/Gender-in-the-NHS.pdf
6. https://www.nhsemployers.org/~/media/Employers/Publications/Gender%20in%20the%20NHS.PDF